Reducing universal health coverage regional disparities in China
Authors: Jay Pan, Chu Chen
Journal: The Lancet Public Health (2022)

Universal health coverage (UHC), target 3.8 of the Sustainable Development Goals, is an essential health priority for all UN Member States, which ensures that access to high-quality health services should be obtainable for every citizen without suffering from financial hardship.1WHOUniversal health coverage.https://www.who.int/health-topics/universal-health-coverage#tab=tab_1Date: 2022Date accessed: September 17, 2022Google Scholar The feasibility of achieving this goal has been further enhanced by WHO and The World Bank; they state that all countries should strive towards at least 80% coverage of essential health services and 100% coverage of financial protection by 2030 as a key milestone, reflective of their progress towards UHC.2WHOTracking universal health coverage: first global monitoring report.https://www.who.int/publications/i/item/9789241564977Date: 2015Date accessed: September 17, 2022Google Scholar As such, most countries are addressing UHC as the primary goal of their national health policies, and China is no exception.3WHOUniversal health coverage and health reform in China.https://www.who.int/china/health-topics/universal-health-coverageDate: 2022Date accessed: September 17, 2022Google Scholar To track progress and achieve UHC, surveillance should be done on an ongoing basis to collect and analyse timely data, which should be used to inform policy and practice improvements. In this issue of The Lancet Public Health, Ying Zhou and colleagues4Zhou Y Li C Wang M et al.Universal health coverage in China: a serial national cross-sectional study of surveys from 2003 to 2018.Lancet Public Health. 2022; 7: e1051-e1063Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar have made substantial contributions to the assessment of UHC progress in China. Based on the development of a composite index from the dimensions of service coverage and financial protection, their study investigates China's UHC progress using nationally representative, population-based household survey data. As suggested by their findings, China has made a remarkable progress towards achieving nationwide UHC, from 44·0% (95% CI 43·0–44·9) in 2003 to 79·8% (79·2–80·3) in 2018. Nevertheless, the study also reported large disparities in UHC across different regions in China. Such disparities found in regional UHC progress pose huge hindrance to the whole nation's progress. Such disparities also indirectly show the inefficiency of the development-targeted resource allocation across the entire nation due to the law of diminishing marginal returns. The same amount of incremental investment would produce less progress towards UHC in the developed areas compared with their counterparts.5Anand S Fan VY Zhang J et al.China's human resources for health: quantity, quality, and distribution.Lancet. 2008; 372: 1774-1781Summary Full Text Full Text PDF PubMed Scopus (239) Google Scholar, 6Tian F Pan J Hospital bed supply and inequality as determinants of maternal mortality in China between 2004 and 2016.Int J Equity Health. 2021; 20: 1-15Crossref PubMed Scopus (12) Google Scholar In the coming decades, reducing regional disparities will be a daunting challenge for China. Gaps in health-related investment and investment-output efficiency might be the principal causes for the regional disparities in UHC progress seen in China. Therefore, two possible solutions to reduce these disparities are: to minimise the gaps in health-related investment among regions via a national-to-regional strategy; and to maximise the investment output under region-specific contexts via the pilot reform monitoring and evaluation in the real-world setting. At the national level, health resources distributed across the nation should be managed via a national-to-regional strategy. Regional health-related investments largely depend on local socioeconomic development.7Pan J Liu GG The determinants of Chinese provincial government health expenditures: evidence from 2002–2006 data.Health Econ. 2012; 21: 757-777Crossref PubMed Scopus (37) Google Scholar The uneven socioeconomic development among regions will remain a long-term issue. As such, the central government-facilitated health resource planning, in terms of supply and demand, should be addressed as one of the key solutions to balancing health resources across regions, instead of relying on locally fragmented decisions. Policy making through centralised planning also has great potential to improve the accuracy of solutions from a holistic perspective. This can be supported by multiple existing studies regarding policy simulation, which suggest that rational allocation of health resources across regions not only mitigates the maldistribution issue to a large extent, but also promotes allocative efficiency, even without changing the total amount of health resources available.8Zhang Y Yang H Pan J Gaining from rational health planning: Spatial reallocation of top-tier general hospital beds in China.Comput Ind Eng. 2021; 157107344Crossref Scopus (8) Google Scholar At the regional level, evidence-based decision-making approaches under region-specific contexts should play a pivotal part in maximising the output of health-related investments. In the past decades, China has launched a series of national strategic plans, including a new round of national health reform in 2009,9Yip W Fu H Chen AT et al.10 years of health-care reform in China: progress and gaps in Universal Health Coverage.Lancet. 2019; 394: 1192-1204Summary Full Text Full Text PDF PubMed Scopus (427) Google Scholar the campaign of Chinese poverty alleviation in 2012,10Pan J Chen C Yang Y Building a global community of shared future free from poverty.Glob Health J. 2021; 5: 113-115Crossref PubMed Scopus (3) Google Scholar and the Healthy China 2030 initiative in 2016,11Zhang C Gong P Healthy China: from words to actions.Lancet Public Health. 2019; 4: e438-e439Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar which are all directly or closely associated with health development. In response to the implementation of these strategic plans, a wide range of renovative and innovative policy pilots have been done among different regions, which naturally serve as an ideal laboratory for policy to assess the effectiveness of the pilots implemented. The consequence of implementing those policies should be monitored and evaluated by a scientific approach based on the data collected under real-world settings. The outcomes analysis of these pilots would have great potential to inform policy and practice improvements under different region-specific contexts, potentially boosting the efficiency of health-related investments at the regional level. The ongoing COVID-19 pandemic, along with its consequent economic downturn, has created a challenging climate for nations on their way to achieving UHC goals. Under such circumstances, the implementation of the two proposed approaches has become rather essential for ensuring effective allocation and use of health-related investments, especially under exacerbated resource constraints. From a long-term perspective, the policy interventions made at both national and regional levels would serve as a substantial contributor to boost progress towards UHC goals. We declare no competing interests. Universal health coverage in China: a serial national cross-sectional study of surveys from 2003 to 2018Although considerable achievements have been made, the progress towards UHC is not keeping pace with the rapid society development in China. Considering an increased burden in non-communicable diseases and an ageing population, prioritising the efficacy of financial investment and optimising resource allocation by strengthening primary health care are necessary to achieve UHC in China. Full-Text PDF Open Access